National Comorbidity Survey - Adolescent (NCS-A)

在过去的一年里，我们继续积极研究与国家心理健康研究所、校内研究计划任务相关的主题，如焦虑症、注意力缺陷多动障碍(ADHD)、情绪障碍、睡眠模式和问题、服务利用以及精神障碍的邻里风险因素。这项研究产生了几篇同行评议的出版物。主要研究结果包括： -广泛性焦虑症(GAD)的阈值和阈值以下形式在青少年中普遍存在，精神疾病的共病、残疾和损害程度很高。研究结果表明，与阈值下GAD相比，阈值GAD的严重程度和慢性化程度更高，然而，阈值下GAD青少年所经历的痛苦和损害通常与那些完全符合障碍标准的人相当，并且同样值得专业或科学关注(Burstein等人，2014)； -使用地理编码将邻近条件与NCS-A数据相关联。邻里劣势和唾液皮质醇水平的关联研究结果表明，居住地可能会影响美国青少年的压力反应系统(Rudolph等人，2014)； -患有双相情感障碍的青少年接受治疗的比例很低；在接受治疗的青少年中，许多人接受的是合并症治疗，而不是与情绪有关的症状。这些发现还突出了双相情感障碍青年临床样本的偏见来源(Khazanov等人，2014年)； -患有神经性暴食症的成年人和青少年有自杀想法和行为的高风险。这一发现强调了解决有进食障碍症状的青少年和成年人自杀风险的重要性(Crow等人，2014年)。 公共卫生影响： 我们继续在现象学层面上提供具有全国代表性的美国青少年样本中各种精神障碍的患病率、相关性和服务模式的数据。我们的研究还表明，邻里因素在青少年精神障碍的发展中可能起着重要作用。我们认为，这些发现为未来的研究和治疗干预提供了有益的信息。随着心理健康治疗研究转向将基于实验室的研究结果转化为治疗干预措施，服务水平数据为我们提供了一种途径，可以将我们之前的翻译研究纳入背景，并进一步增强后续干预措施。虽然干预措施的发展很重要，但干预措施的最终成功取决于这种干预措施融入现有医疗系统的方式。在这一组内进行的服务利用研究提供了对可从有针对性的干预措施中受益的人群和服务部门的一些洞察。 未来计划： 我们还积极开展下列项目，制作了几份已提交或准备提交的重要手稿： -描述美国青少年中严重抑郁障碍的程度及其严重形式，并检查社会人口相关、共病、损害和治疗模式(Avenevi等人，2014年提交)； -审查在达到药物使用每个阶段(从第一次使用到依赖)的青少年中先前精神障碍的总体流行率，并估计先前精神障碍对从较早使用阶段过渡到较晚使用阶段的可能性的影响(Swendsen等人，2014年准备提交)； -估计失眠症状的流行率和健康相关性及其与青少年共病精神障碍的关系(Blank等人，2014年在媒体上)； -检查被诊断为多动症的青少年的身体共病(Jameson等人，2014年提交)； -评估新的DSM-5标签对破坏性情绪调节障碍(DMDD)的效用(Althoff等人，2014年正在审查中)； -了解青少年精神病理学的多样性，使用一种新的方法来描述在反映主要精神病理学维度的虚拟空间中精神障碍共同发生的频率；检查主要精神病理学维度是否可以分级组织；并确定个人潜在分数在这些维度所跨越的空间中的分布(Blanco等人，2014年提交)； -评估青少年严重抑郁障碍临床试验的普适性；鉴于目前的临床试验做法可能排除了绝大多数患有严重抑郁障碍的青少年(Blanco等人，2014年提交)。 我们还在对以下主题进行进一步的分析：1)美国青少年的开学时间和睡眠模式；2)青少年的住宿和学校流动性与精神障碍；3)易怒作为抑郁的指标；以及4)恐慌症的共病和相关因素。

During the past year, we have continued to actively pursue analyses of topics relevant to the National Institute of Mental Health, Intramural Research Program mission such as anxiety disorders, attention deficit hyperactivity disorder (ADHD), mood disorders, sleep patterns and problems, service utilization, and neighborhood risk factors for mental disorders. The research yielded several peer-reviewed publications. The chief findings include: -Threshold and subthreshold forms of generalized anxiety disorder (GAD) are prevalent in adolescents with a high degree of psychiatric comorbidity, disability and impairment. The findings indicate that threshold GAD may be typified by greater severity and chronicity than subthreshold GAD, however the distress and impairment experienced by adolescents with subthreshold GAD is often comparable with that of those who meet full criteria for the disorder, and no less worthy of professional or scientific attention (Burstein et al, 2014); -Neighborhood conditions are linked with NCS-A data using geocoding. The findings of the association of neighborhood disadvantage and salivary cortisol levels suggest place of residence may influence the stress response system in U.S. adolescents (Rudolph et al, 2014); -The proportion of adolescents with bipolar disorder who received treatment is substantially low; and of those who do, many receive treatment for comorbid conditions rather than for their mood-related symptoms. These findings also highlight the sources of bias of clinical samples of youth with bipolar disorder (Khazanov et al, 2014); -There is a high risk of suicidal ideation and behavior among adults and adolescents with bulimia nervosa. The findings underscore the importance of addressing suicide risk in adolescents and adults with eating disorder symptoms (Crow et al, 2014). Public Health Impact: We have continued to provide data on the prevalence, correlates and service patterns at the phenomenologic level on a wide range of psychiatric disorders in a nationally representative sample of U.S. adolescents. Our study also demonstrated that neighborhood factors may play important roles in the development of mental disorders in adolescents. We believe that these findings provide beneficial information to inform future research and treatment interventions. As mental health treatment research is moving into the translation of lab-based findings to treatment interventions, service level data provides us with an avenue to put our previous translational research into context and further enhance subsequent interventions. While the development of interventions is important, the ultimate success of intervention is predicated on the way this intervention is integrated into the existing medical system. Service utilization studies conducted within this group provide some insight into the populations and service sectors that could benefit from targeted interventions. Future Plans: We have also actively worked on the following projects that produced several important manuscripts that are either submitted or ready for submission: -Describe the magnitude of major depressive disorder and its severe form in U.S. adolescents and examine sociodemographic correlates, comorbidity, impairment and treatment patterns (Avenevoli et al, 2014 submitted); -Examine the overall prevalence of prior mental disorders among adolescents having attained each stage of substance use (from first use to dependence) and estimate the influence of prior mental disorders in the probability of transition from earlier to later stage of use (Swendsen et al, 2014 ready for submission); -Estimate the prevalence and health correlates of insomnia symptoms and their association with comorbid mental disorders in adolescents (Blank et al, 2014 in press); -Examine physical comorbidity among adolescents with a diagnosis of ADHD (Jameson et al, 2014 submitted); -Assess utility of the new DSM-5 label for disruptive mood dysregulation disorder (DMDD) (Althoff et al, 2014 under review); -Understand the diversity of psychopathology in adolescents by using a novel approach to describe the frequency of co-occurrence of psychiatric disorders in a virtual space that spanned by factors reflecting major psychopathologic dimensions; examine whether the major psychopathological dimensions can be hierarchically organized; and determine the distribution of the latent scores of individuals in the space spanned by those dimensions (Blanco et al, 2014 submitted); -Assess the generalizability of adolescent clinical trials of major depressive disorder; given that current practice of the clinical trials likely exclude a great majority of adolescents with major depressive disorder (Blanco et al, 2014 submitted). We are also pursuing additional analyses on the following topics: 1) school start time and sleep patterns among U.S. adolescents; 2) residential and school mobility and mental disorders in adolescents; 3) irritability as an index of depression; and 4) comorbidity and correlates of panic disorder.